Provider Demographics
NPI:1831178474
Name:TRISTANI, STEPHEN E (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:TRISTANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MACPHAIL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4309
Mailing Address - Country:US
Mailing Address - Phone:410-638-7367
Mailing Address - Fax:410-877-9199
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4309
Practice Address - Country:US
Practice Address - Phone:410-638-7367
Practice Address - Fax:410-877-9199
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12871OtherMD PHARMACIST'S LICENSE